The Birth and Death of Single-Payer in the Democratic Party

In 1988, Jesse Jackson ran for president on a platform of uniting workers and pushing universalist policies like single-payer. His success terrified neoliberals in the Democratic Party.

Curt Anderson, Decatur "Bucky" Trotter, and Jesse Jackson during a Black Caucus meeting in Annapolis, Maryland, 1988. 1msulax / Wikimedia

In 1984, I became the health adviser to Jesse Jackson’s presidential campaign after Dr Quentin Young, one of my best friends and a well-known progressive physician in Chicago, suggested that the three of us meet. Quentin knew Jesse very well. Besides serving as Jesse’s personal physician, Quentin had developed a close working relationship with Jackson. Jesse had (and has) a very engaging personality, and Quentin was known for his persuasiveness. I accepted their proposal to advise Jesse in the Democratic Party primaries — an experience that became my baptism of fire in American politics (I had arrived in 1965 as a political exile from Franco’s Spain).

I had total loyalty to Jesse Jackson. He was, and remains, one of the most articulate leaders I have ever known, among the many that I have advised in many countries. But I was not convinced his strategy would lead him to the White House in 1984. Competing with Walter Mondale (close to former Vice President Hubert Humphrey), Jackson ran as (and was perceived as) the voice of racial minorities and the excluded, demanding to be recognized as part of the Democratic Party — a very necessary task, but different than aspiring to be president of the United States.

The New York Times loved it, and wrote an editorial that not even Jesse’s mother would have written, putting him on a pedestal. My worry was that his strategy would not gain him the broad support needed to become president — those who were not minorities or did not feel discriminated against would not vote for him. My impression was that although Jackson ran for president, he did not believe he could become president. He thought the United States was not ready for a black president. I disagreed. But with his strategy, emphasizing the voice of the minorities and the excluded, he obtained only a minority of the delegates in the Democratic Convention.

In 1988, Jackson ran a different campaign. He pitched himself as the voice of the working class (although without using the phrase, a forbidden term in the language of US politics). He spoke of “working families,” putting great emphasis on the need to unite different sectors of society and progressive social movements. Adding up the different sectors — black, white, and other races — we were the majority of the popular classes: the Rainbow Coalition. We emphasized universal policies in his proposals, such as a National Health Program that would guarantee health care not only for black people and the poor, but for everyone else, i.e. the majority of the people.

When, in the 1988 campaign, Jesse came to Baltimore (at that time a steel town), journalists would ask him, “How are you going to get the support of the white steelworker?” He would answer: “By making him [the majority were men] aware that he has more in common with the black steelworker, because they are both workers, than he does with the boss because they are white.” Social class was the underlying theme, and universality (establishing access to health care as a right) was the guiding principle. This time, the New York Times wrote a nasty editorial warning that Jesse would destroy the United States.

Jackson performed much better this time around, almost winning the most elected delegates in the Democratic Party convention in Atlanta. It was an impressive mobilization of all sectors against the neoliberal establishment led by his opponent, the governor of Massachusetts, Michael Dukakis. Such mobilization frightened the conservative wing of the Democratic Party based in the South, led by Albert Gore and Bill Clinton.

Their response was Clinton’s candidacy in 1992. He won that year, astutely borrowing from Jesse’s 1988 proposals — including keeping the call for a national health program, though diluting the call for universality and public funding.

The Clinton Administration and Its Response to Jesse Jackson’s Threat

One of the first things President Clinton did once in the White House was appoint the Healthcare Reform Task Force, chaired by Hillary Clinton. It was a direct response to the need to do something about the popular claim for a National Health Program, which Jackson’s 1988 campaign — unlike his bid four years earlier — had brought to the fore.

The shape of the plan Clinton was calling for, however, was clearly defined by the composition of the task force. No pro-single-payer person was on the panel, which provoked a protest from Jesse Jackson. He, Dennis Rivera (the head of the 1199 National Health Workers’ Union), Quentin Young, and I went to see Hillary Clinton to complain about her exclusion of single-payer as an alternative. As a consequence of the meeting, she asked Jesse to send someone with that orientation.

This is how I came to sit on a task force chaired by Hillary Clinton. My influence in the Task Force, however, was nil: I was included as the token “single-payer” (besides being the token “Latino”).  My only contribution seems to have been to alarm the ultra right wing of the country. My presence —     as a well-known “red” — was used to accused Hillary Clinton of being under the influence of the same expert who had advised President Allende in Chile and Fidel Castro in Cuba (I had indeed had the honor of advising both of them in their healthcare reforms, as I had also advised the Swedish and the Spanish Social Democratic governments, which of course was not mentioned by my opponents in the White House).

A nasty book against Hillary was written called The Seduction of Hillary Rodham, in which I was presented as one of the seducers, supposedly very influential in the development of her program. But my influence was minimal, except for a few days, after President Clinton received a letter signed by thousands of people calling for single payer. The leadership of the task force asked what could be done, to which I responded: add a sentence in the proposed bill allowing those states who wanted to set up a single-payer program to do so (this is how it was established in Canada, after a single-payer proposal was approved in the Western province of Saskatchewan). My proposal was promptly dismissed. And so my nonexistent influence came to an end.

It was not a complete waste of time, however. I learned from that experience that the president of the United States is not the most powerful person in the country. Far from it. In the first sentence of that splendid document, the US Constitution, which says “We the people decide,” there is an unwritten footnote that adds “and the insurance companies.” When my proposal was dismissed by the directors of the White House Health Care Reform Task Force, the argument used was that such an amendment would not last more than a couple of days in the congressional committee, who would have to approve the proposed reform. Actually, it lasted less than two days. It was never proposed.

Later on, single-payer appeared in the discourse of another patient of Quentin Young, also from Chicago: Barack Obama — only to disappear again when he decided to run for president. Financial capital, including insurance companies and Wall Street, funded part of his campaign. And the Constitution’s Footnote silenced again that possibility — showing once more that democracy is very seriously limited in the United States.